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Abstract
Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.
Keywords
dignity, respect, patient-centered care, patient engagement, patient experience, INTENSIVE-CARE-UNIT, READMISSIONS REDUCTION PROGRAM, FAMILY SATISFACTION, BURNOUT SYNDROME, PATIENT DIGNITY, HOSPITAL-CARE, PERCEPTIONS, PROFESSIONALS, ENGAGEMENT, PHYSICIANS

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Citation

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MLA
Brown, Samuel M, Elie Azoulay, Dominique Benoit, et al. “The Practice of Respect in the ICU.” AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 197.11 (2018): 1389–1395. Print.
APA
Brown, S. M., Azoulay, E., Benoit, D., Butler, T. P., Folcarelli, P., Geller, G., Rozenblum, R., et al. (2018). The practice of respect in the ICU. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 197(11), 1389–1395.
Chicago author-date
Brown, Samuel M, Elie Azoulay, Dominique Benoit, Terri Payne Butler, Patricia Folcarelli, Gail Geller, Ronen Rozenblum, et al. 2018. “The Practice of Respect in the ICU.” American Journal of Respiratory and Critical Care Medicine 197 (11): 1389–1395.
Chicago author-date (all authors)
Brown, Samuel M, Elie Azoulay, Dominique Benoit, Terri Payne Butler, Patricia Folcarelli, Gail Geller, Ronen Rozenblum, Ken Sands, Lauge Sokol-Hessner, Daniel Talmor, Kathleen Turner, and Michael D Howell. 2018. “The Practice of Respect in the ICU.” American Journal of Respiratory and Critical Care Medicine 197 (11): 1389–1395.
Vancouver
1.
Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, et al. The practice of respect in the ICU. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. 2018;197(11):1389–95.
IEEE
[1]
S. M. Brown et al., “The practice of respect in the ICU,” AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 197, no. 11, pp. 1389–1395, 2018.
@article{8585800,
  abstract     = {Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.},
  author       = {Brown, Samuel M and Azoulay, Elie and Benoit, Dominique and Butler, Terri Payne and Folcarelli, Patricia and Geller, Gail and Rozenblum, Ronen and Sands, Ken and Sokol-Hessner, Lauge and Talmor, Daniel and Turner, Kathleen and Howell, Michael D},
  issn         = {1073-449X},
  journal      = {AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE},
  keywords     = {dignity,respect,patient-centered care,patient engagement,patient experience,INTENSIVE-CARE-UNIT,READMISSIONS REDUCTION PROGRAM,FAMILY SATISFACTION,BURNOUT SYNDROME,PATIENT DIGNITY,HOSPITAL-CARE,PERCEPTIONS,PROFESSIONALS,ENGAGEMENT,PHYSICIANS},
  language     = {eng},
  number       = {11},
  pages        = {1389--1395},
  title        = {The practice of respect in the ICU},
  url          = {http://dx.doi.org/10.1164/rccm.201708-1676cp},
  volume       = {197},
  year         = {2018},
}

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